Measuring Clinical Response and Remission in Juvenile Idiopathic Arthritis

Table 1.

Characteristics of Disease Outcome Measures

Table 2.

Pediatric Core Set Components

Table 3.

Disease Activity Score (DAS) Components and Equations for the DAS and DAS28

Table 4.

Clinical Remission in Juvenile Idiopathic Arthritis

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Biologic Measures of Disease Activity

No formal definition of a biomarker currently exists for use in JIA, but a biomarker ideally would fulfill one or more of several roles. First, a biomarker would facilitate disease classification and would differentiate patients with different disease subtypes. Next, a biomarker would accurately reflect a patient's disease state and would be sensitive to changes in underlying disease activity and treatment effects, allowing providers to follow treatment efficacy. Last, the marker should be able to predict the disease course and identify patients who would be likely to develop severe disease. Candidate biomarkers include single cytokines (i.e. interleukins), cytokine profiles, inflammatory markers (i.e. ESR, C-reactive protein), enzymes (i.e. matrix metalloproteinases^[30]), and autoimmune epiphenomenon (i.e. anticyclic citrullinated peptide antibodies^[31]). The challenges associated with identifying genetic associations and biomarkers in JIA have been recently reviewed in this journal.^[32,33]